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Der Profi wird wettkampffähig, der Amateur arbeitsfähig gemacht

Der Profi wird wettkampffähig, der Amateur arbeitsfähig gemacht

Budgetzwänge: Ungleichbehandlung von Berufs- und Freizeitsportlern in der Kassenarztpraxis

Die Zahl der sportlich aktiven Menschen nimmt ständig zu, die Freizeitgesellschaft fordert immer mehr und immer intensivere sportliche Betätigung und fordert so auch ihren “Tribut”. Die Zahl der Sportverletzungen steigt stetig. Hier sind Bagatell-verletzungen ebenso häufig wie schwere Gelenk- und Muskelverletzungen durch oder bei der sportlichen Betätigung. Tritt eine solche Verletzung auf, so sind die meisten Sportler mit der Erstbehandlung vertraut:
R est
I ce
C ompression
E levation
Die Erstbehandlung ist einfach, kostengünstig und bei den Profis wie auch den Amateuren identisch. Dann allerdings beginnt für manchen Freizeitsportler das Problem. Der Profi wird noch am Tag der Verletzung oder spätestens am Tag danach durch die diagnostische “Mühle” gedreht, wobei keine Kosten gescheut werden: Röntgen, Ultraschall, Kernspintomographie, Konsiliaruntersuchungen von Neurologe und anderen sind dabei kein Problem. Der Freizeitsportler wird zunächst auch klinisch und radiologisch untersucht, die Ultraschalluntersuchung ebenfalls – wenn erforderlich – immer durchgeführt. Beim MRT (Magnet-Resonanz-Tomographie) wird bereits die Notwendigkeit streng geprüft. Die Termine sind allerdings in keinem Fall so schnell zu bekommen wie beim Profi.

Ist die Verletzung in ihrem Ausmaß diagnostiziert und beginnt die konservative Behandlung, so beginnen für den gesetzlich versicherten Sportler – aber vor allem auch für den behandelnden Kassenarzt – die Probleme. Das Problemwort heißt “Budget”. Die kassenärztliche Therapie ist durch ein Budget reglementiert, das sich sowohl auf die Verordnung von Arzneimitteln als auch auf die Verordnung von krankengymnastisch-physikalischen Maßnahmen bezieht. Können derzeit noch diagnostische Verfahren wie das MRT nach ärztlicher Überzeugung eingesetzt werden, so muß bei der Verordnung von Medikamenten sehr streng auf die Einhaltung der Arzneimittelbudgets geachtet werden.

Die bei den Leistungssportlern angewendeten Therapeutika wie zum Beispiel Enzyme, Zink, Vitamin E oder die Injektionslösungen pflanzlicher Herkunft und das oft so gerne zitierte “Kälberblut” bei der Muskelverletzung stehen für einen gesetzlich Versicherten verletzten Sportler nicht zur Verfügung. Werden diese Substanzen dennoch verordnet, so geschieht dies auf Kosten des Arztes oder des Patienten – nicht auf Kosten der Krankenkasse des Patienten .

Gleichzeitig muß auch der Faktor “Zeit” in der Heilung berücksichtigt werden. Der Kassenarzt wird immer wieder mit den Vorgaben aus dem Profisport konfrontiert. Oft klagen Freizeitsport: Der Sportler X war nach derselben Verletzung nach 14 Tagen wieder im Wettkampf, “ich kann noch gar nicht richtig trainieren”. Meist werden hierbei der Trainingszustand des Sportlers, der wesentlich bessere Ausgangsbedingungen für die Rehabilitation bietet als der des Freizeitsportlers, ebenso vergessen wie die Intensität der Akut- und Nachbehandlung. Während ein Profisportler täglich bis zu acht Stunden an seiner Rehabilitation arbeitet, ist es das Primärziel in einer kassenärztlichen Praxis, den Freizeitsportler wieder arbeitsfähig und erst in zweiter Linie wettkampffähig zu machen.

Aus diesem Grund kann der Freizeitsportler das Therapieprogamm nicht wie ein Profisportler gestalten – die Dauer der Rehabilitation ist wesentlich länger. Zudem stehen nur zeitlich begrenzte therapeutische Maßnahmen zur Verfügung, die natürlich auch den Budgetzwängen unterliegen . Der Physiotherapeut, der den verletzten Freizeitsportler behandelt, muß versuchen, möglichst viele Patienten in seiner Praxis zu behandeln, da nur dann die Physiotherapie-Praxis kostendeckend oder gewinnbringend arbeiten kann. Der Physiotherapeut, der den Leistungssportler wieder “fit” macht, kann kosten, was er will und muß sich weitgehend auf diesen Sportler konzentrieren. Hauptsache der Wirtschaftsfaktor “Sportler” ist schnell wieder in seinem Sport zurück. Verein, Sponsoren und Medien sind zufrieden.

Auch in der postoperativen Behandlung zum Beispiel nach einer vorderen Kreuzbandplastik am Kniegelenk tun sich große Unterschiede auf. Der Profi rehabilitiert in einem speziellen Zentrum oder einer Klinik unter stationären Bedingungen. Für den gesetzlich Versicherten sind die stationären Aufenthalte nicht möglich, da die Rentenversicherungsträger als Kostenträger diese Operation (Kreuzbandplastik) aus dem Indikationskatalog gestrichen haben.

Die ambulante Reha als kassenärztlicher Weg der Rehabilitation nach einer Sportverletzung mit Kreuzbandruptur muß erst durch den Medizinischen Dienst der Krankenkasse genehmigt werden. Dies dauert – je nach Kasse – bis zu vier Wochen, wertvolle Zeit die der Rehabilitation fehlt. Dann werden regelhaft statt der verordneten zum Beispiel 24 Therapieeinheiten nur 12 genehmigt, die Intensität der Rehabilitation wird dadurch nochmals reduziert. Stellt man dann den Verlängerungsantrag, muß auch der wieder genehmigt werden. Oft wird er abgelehnt, weil ja jetzt schon mehr als sechs Wochen nach der Operation vergangen sind und normale Krankengymnastik (25 Minuten) ausreichend sein müßte.

So versuchen alle Seiten, die Kosten zu reduzieren, die durch die Vielzahl der Behandelten und die Zunahme der diagnostischen und therapeutischen Möglichkeiten ständig steigen. Der Kassenarzt ist aus diesem Grund gar nicht so glücklich, einen anspruchsvollen, gesetzlich versicherten Sportler mit einer intensiv therapiebedürftigen Sportverletzung zu behandeln – und dies vielleicht auch noch erfolgreich! Denn bei den Sportlern ist die Mundpropaganda sehr intensiv und der kassenärztlich tätige Sportmediziner hat dann das Problem, immer mehr Sportverletzte zur Therapie zu bekommen – und dann entweder draufzuzahlen oder die Therapie umzustellen. Dann wird aber auch der Erfolg ausbleiben.

Volkswirtschaftlich betrachtet ist die Zunahme der Sportverletzungen, auch der Bagatellverletzungen, ein Fiasko, denn die Kosten für eine adäquate Therapie sprengen jedes Budget und können nur bei den Profisportlern durch die Berufsgenossenschaften oder die Vereine aufgebracht werden. Der gesetzlich versicherte Patient muß das Glück haben, einen engagierten Sportmediziner mit entsprechend großem Arzneimittelschrank als Therapeuten zu haben oder – und das ist die Regel – einen längeren Heilungsprozess akzeptieren.

20. August 2002

Dr. med. Michael Krüger-Franke, München

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  191. volante de equilibrado con cesta de embrague

    Dicho girador de nivelacion con recipiente de embrague simboliza un proceso primordial para verificar el operacion ideal del propulsor y la impulsion de un automotor. El falta de equilibrio en la presente componente tiende a causar temblores, estrepito, desgaste acelerado de los elementos e llegando a averias. Anteriormente, el nivelacion se llevaba a cabo una vez quitar el volador del propulsion, sin embargo las tecnologias recientes permiten realizar el mencionado proceso de forma directa en el transporte, lo que esto disminuye plazo y dinero.

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    El desequilibrio representa una situacion en la donde la peso de un pieza giratoria (en este particular escenario, el girador de nivelacion con cesta de embrague) se localiza de modo irregular en relacion con su centro de giro de revolucion. Lo cual genera cargas centrifugas que a su vez provocan oscilaciones.

    Principales del Desequilibrio del Volador de Estabilizacion con Compartimento de Embrague:

    Desviaciones de produccion y ensamblaje: Aunque insignificantes divergencias en la geometria de los componentes tienden a originar desequilibrio.
    Desgaste y averias: El tiempo de uso, el exceso de calor y los danos mecanicos pueden cambiar la masa y dar lugar en desbalance.
    Ensamblaje o servicio inadecuada: Una ensamblaje deficiente de la compartimento de embrague o servicios incorrectos de igual manera llegan a originar desequilibrio.

  195. El volante de equilibrado con compartimento de embrague constituye un procedimiento critico con el proposito de garantizar el funcionamiento perfecto del unidad y la transferencia de un camion. El desbalance en esta parte tiende a provocar temblores, estrepito, desgaste excesivo de los piezas e incluso fallos. Historicamente, el equilibrado se ejecutaba despues de retirar el volante del unidad, pero las tecnologias contemporaneas facilitan ejecutar dicho proceso de forma directa en el vehiculo, lo cual minimiza duracion y presupuesto.

    Como se define el Falta de equilibrio?

    El falta de equilibrio simboliza una condicion en la donde la masa de un componente rotacional (en este caso, el volador de estabilizacion con canasto de embrague) se reparte de modo desigual en comparacion a su punto de rotacion de movimiento circular. Esta situacion genera tensiones centrifugas las cuales originan sacudidas.

    Principales del Falta de equilibrio del Volante de Balanceo con Cesta de Embrague:

    Imprecisiones de manufactura y ensamblaje: Aun pequenas desviaciones en la geometria de los componentes pueden causar desajuste.
    Uso y desperfectos: El funcionamiento prolongado, el altas temperaturas y los danos mecanicos podrian afectar la volumen y provocar en desajuste.
    Instalacion o arreglo inapropiada: Una colocacion incorrecta de la compartimento de embrague o servicios inadecuados tambien pueden causar desbalance.

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  201. 娛樂城推薦與優惠詳解

    在現今的娛樂世界中，線上娛樂城已成為眾多玩家的首選。無論是喜歡真人遊戲、老虎機還是體育賽事，每個玩家都能在娛樂城中找到自己的樂趣。以下是一些熱門的娛樂城及其優惠活動，幫助您在選擇娛樂平台時做出明智的決定。

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    1. 富遊娛樂城
    富遊娛樂城以其豐富的遊戲選擇和慷慨的優惠活動吸引了大量玩家。新會員只需註冊即可免費獲得體驗金 $168，無需儲值即可輕鬆試玩。此外，富遊娛樂城還提供首存禮金 100% 獎勵，最高可領取 $1000。

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    AT99娛樂城以高品質的遊戲體驗和優秀的客戶服務聞名。該平台提供各種老虎機和真人遊戲，並定期推出新遊戲，讓玩家保持新鮮感。

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    BCR娛樂城是一個新興的平台，專注於提供豐富的體育賽事投注選項。無論是足球、籃球還是其他體育賽事，BCR都能為玩家提供即時的投注體驗。

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    戰神賽特老虎機以其獨特的主題和豐富的獎勵機制，成為老虎機愛好者的最愛。該遊戲結合了古代戰神的故事背景，讓玩家在遊戲過程中感受到無窮的樂趣。

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    富遊娛樂城註冊送體驗金
    富遊娛樂城新會員獨享 $168 體驗金，無需儲值即可享受全場遊戲，讓您無壓力地體驗不同遊戲的魅力。

    VIP 日日返水無上限
    富遊娛樂城為 VIP 會員提供無上限的返水優惠，最高可達 0.7%。此活動讓玩家在遊戲的同時，還能享受額外的回饋。

    結論
    選擇合適的娛樂城不僅能為您的遊戲體驗增色不少，還能通過各種優惠活動獲得更多的利益。無論是新會員還是資深玩家，都能在這些推薦的娛樂城中找到適合自己的遊戲和活動。立即註冊並體驗這些優質娛樂平台，享受無限的遊戲樂趣！

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  210. 娛樂城推薦與優惠詳解

    在現今的娛樂世界中，線上娛樂城已成為眾多玩家的首選。無論是喜歡真人遊戲、老虎機還是體育賽事，每個玩家都能在娛樂城中找到自己的樂趣。以下是一些熱門的娛樂城及其優惠活動，幫助您在選擇娛樂平台時做出明智的決定。

    各大熱門娛樂城介紹
    1. 富遊娛樂城
    富遊娛樂城以其豐富的遊戲選擇和慷慨的優惠活動吸引了大量玩家。新會員只需註冊即可免費獲得體驗金 $168，無需儲值即可輕鬆試玩。此外，富遊娛樂城還提供首存禮金 100% 獎勵，最高可領取 $1000。

    2. AT99娛樂城
    AT99娛樂城以高品質的遊戲體驗和優秀的客戶服務聞名。該平台提供各種老虎機和真人遊戲，並定期推出新遊戲，讓玩家保持新鮮感。

    3. BCR娛樂城
    BCR娛樂城是一個新興的平台，專注於提供豐富的體育賽事投注選項。無論是足球、籃球還是其他體育賽事，BCR都能為玩家提供即時的投注體驗。

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    WM真人視訊百家樂
    WM真人視訊百家樂是許多玩家的首選，該遊戲提供了真實的賭場體驗，並且玩法簡單，容易上手。

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    戰神賽特老虎機以其獨特的主題和豐富的獎勵機制，成為老虎機愛好者的最愛。該遊戲結合了古代戰神的故事背景，讓玩家在遊戲過程中感受到無窮的樂趣。

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    富遊娛樂城註冊送體驗金
    富遊娛樂城新會員獨享 $168 體驗金，無需儲值即可享受全場遊戲，讓您無壓力地體驗不同遊戲的魅力。

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    結論
    選擇合適的娛樂城不僅能為您的遊戲體驗增色不少，還能通過各種優惠活動獲得更多的利益。無論是新會員還是資深玩家，都能在這些推薦的娛樂城中找到適合自己的遊戲和活動。立即註冊並體驗這些優質娛樂平台，享受無限的遊戲樂趣！

  212. 娛樂城推薦與優惠詳解

    在現今的娛樂世界中，線上娛樂城已成為眾多玩家的首選。無論是喜歡真人遊戲、老虎機還是體育賽事，每個玩家都能在娛樂城中找到自己的樂趣。以下是一些熱門的娛樂城及其優惠活動，幫助您在選擇娛樂平台時做出明智的決定。

    各大熱門娛樂城介紹
    1. 富遊娛樂城
    富遊娛樂城以其豐富的遊戲選擇和慷慨的優惠活動吸引了大量玩家。新會員只需註冊即可免費獲得體驗金 $168，無需儲值即可輕鬆試玩。此外，富遊娛樂城還提供首存禮金 100% 獎勵，最高可領取 $1000。

    2. AT99娛樂城
    AT99娛樂城以高品質的遊戲體驗和優秀的客戶服務聞名。該平台提供各種老虎機和真人遊戲，並定期推出新遊戲，讓玩家保持新鮮感。

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    BCR娛樂城是一個新興的平台，專注於提供豐富的體育賽事投注選項。無論是足球、籃球還是其他體育賽事，BCR都能為玩家提供即時的投注體驗。

    熱門遊戲推薦
    WM真人視訊百家樂
    WM真人視訊百家樂是許多玩家的首選，該遊戲提供了真實的賭場體驗，並且玩法簡單，容易上手。

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    戰神賽特老虎機以其獨特的主題和豐富的獎勵機制，成為老虎機愛好者的最愛。該遊戲結合了古代戰神的故事背景，讓玩家在遊戲過程中感受到無窮的樂趣。

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    富遊娛樂城註冊送體驗金
    富遊娛樂城新會員獨享 $168 體驗金，無需儲值即可享受全場遊戲，讓您無壓力地體驗不同遊戲的魅力。

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    富遊娛樂城為 VIP 會員提供無上限的返水優惠，最高可達 0.7%。此活動讓玩家在遊戲的同時，還能享受額外的回饋。

    結論
    選擇合適的娛樂城不僅能為您的遊戲體驗增色不少，還能通過各種優惠活動獲得更多的利益。無論是新會員還是資深玩家，都能在這些推薦的娛樂城中找到適合自己的遊戲和活動。立即註冊並體驗這些優質娛樂平台，享受無限的遊戲樂趣！

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